Superiority of antegrade cardioplegia over continuous hypothermic retrograde cardioplegia in myocardial protection during isolated aortic valve replacement

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Objectives: The efficacy of antegrade cardioplegia delivery (ACD) versus retrograde cardioplegia delivery remains controversial. This study aimed to compare the efficacy of intermittent and isothermic ACD (IIACD) with continuous and hypothermic retrograde cardioplegia delivery (CHRCD) in patients undergoing isolated aortic valve replacement (AVR). Methods: This retrospective study reviewed 164 patients who underwent isolated AVR. After propensity score matching was performed for age, sex, body surface area, European System for Cardiac Operative Risk Evaluation, operation time, cardiopulmonary bypass time, and aortic crossclamp time, 62 patients were assigned to either the IIACD or CHRCD group. Myocardial injury was assessed using peak levels of creatine kinase-MB (CK-MB) and aspartate aminotransferase (AST) level within 1 week postoperatively. Echocardiographic changes and clinical outcomes were also evaluated. Results: < .001. There were no significant differences in postoperative ejection fraction or mortality between the groups. Conclusions: Despite the use of continuous hypothermic cardioplegia in the CHRCD group, IIACD provided superior myocardial protection. ACD may offer a safer cardioplegia strategy during AVR.

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